小儿体外循环手术围术期细胞间粘附分子-1的测定

Detection of Intercellular Adhesion Molecule-1 during Pediatric Cardiopulmonary Bypass

目的 :探讨小儿体外循环 (CPB)围术期血清细胞间粘附分子 1 (ICAM 1 )水平变化规律和升高原因及测定的临床意义。方法 :采用双抗夹心法酶联吸附试验 (ELISA)法分别于手术前、转流后 3 0min、手术毕、术后 2h、1 2h、2 4h、48h共 7个时点测定 3 3例先天性心脏病 (CHD)患儿 ;分别于术前 ,术中及术后 2h测定 1 0例非体外循环普胸手术患儿及 3 0例健康体检患儿ICAM 1水平。结果 :CHD术前ICAM 1无变化 ;CPB术后ICAM 1水平较非CPB明显升高 ,P <0 .0 0 5 ;血清ICAM 1值于CPB 3 0min后开始上升 ,至 2 4h达到高峰后开始下降 ,48h尚未降至术前水平 ;CPB时间≥ 90min组ICAM 1显著升高 ,P <0 .0 5。结论 :小儿CPB心脏直视手术后血清ICAM 1升高明显 ,CPB时间是ICAM 1升高的主要原因 ,ICAM 1测定对预防及早期发现并发症有一定的临床意义。

Objective:To evaluate the role of serum intercellular adhesion molecule (ICAM 1) changes during pediatric cardiopulmonary bypass (CPB) surgery for congenital heart diseases (CHD) and the clinic significance of monitoring the serum ICAM 1 level.Methods:ICAM 1 levels were measured by double antibodies sandwich ELISA in arterial specimen from 33 CPB cases at various time points,the results were compared with those of 10 non CPB patients and 30 normal children.Results:Patients with CHD had normal levels of serum ICAM 1 before surgery.The serum ICAM 1 levels in CPB group were significantly higher than those of controls ( P <0.005).ICAM 1 levels started increasing as early as 30 minutes of CPB began and peaked 24 hours after surgery and stayed up 48 hours after surgery .The serum ICAM 1 levels in patients whose CPB lasted longer than 90 minuets were significantly higher ( P <0.05).Conclusion:ICAM 1 showed higher and lasted longer after pediatric CPB surgery.The length of CPB is associated with elevation of ICAM 1.Monitoring of serum ICAM 1,in certain degree,may help in predicting prognosis and complication after CPB surgery.